M. Bemelmans, S. Baert, E. Goemaere, L. Wilkinson, M. Vandendyck, G. Van Cutsem, C. Silva, S. Perry, E Szumilin, R. Gerstenhaber, L. Kalenga, M. Biot, N. Ford MSF OCB Scientific day 2014 Community-supported models of care for people on HIV treatment in sub-Saharan Africa
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M. Bemelmans, S. Baert, E. Goemaere, L. Wilkinson, M. Vandendyck, G. Van Cutsem, C. Silva, S. Perry, E Szumilin, R. Gerstenhaber, L. Kalenga, M. Biot,
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M. Bemelmans, S. Baert, E. Goemaere, L. Wilkinson, M. Vandendyck, G. Van Cutsem, C. Silva, S. Perry, E Szumilin, R. Gerstenhaber, L. Kalenga, M. Biot, N. Ford
MSF OCB Scientific day 2014
Community-supported models of care for people on HIV treatment in sub-Saharan Africa
Peter Casaer
STABLE patient on ART
Monthly clinic visit for
consultationand ART refill
How to deal with a
growing cohort of
stable patients on ART?
Peter Casaer
Mozambique
MalawiDR Congo
South Africa
Community-supported models of care
Project Chiradzulu, Malawi
Khayelitsha, South Africa
Kinshasa, DR Congo
Tete, Mozambique
Context Rural Urban Urban Rural
ART refill 3-monthly 2-monthly 3-monthly Monthly
Mode Individual Group Individual Group
Where Health facility Health facility or community venues
Community distribution points
Patients’ homes
Led by Lay worker Lay worker Lay worker of network of PLHIV
Better retention than in Better retention than in conventional careconventional care
“… belonging to a group strengthens people. Moreover, being united people become mentally stronger during treatment compared to those who do it individually.”
CAG leader, Tete, Mozambique
Rasschaert, 2014
Lower Service
Provider Costs
Cost per patient per year
Adherence club 58 US$
Conventional care 109 US$
Bango, 2013
Samantha Reinders
Strong publication and dissemination efforts
Major impact on national & international policy
What is MSF’s responsability
in national roll-outs?
Critical enablers
André Francois
Brendan Bannon
Brendan Bannon
Miguel Cuenca
Recognition of lay workers
Robust drug supplyReliable monitoring system
Acces to quality clinical managementRealistic planningFlexible adaptations
ConclusionConclusion
• Community supported models respond to the needs of a growing cohort of stable patients on ART and their health care workers
• Adaptation of these models is ongoing to include other HIV+ patients and allow for a wider application to other diseases
• Further analysis and advocacy is needed to ensure models are adapted to contexts and critical enablers are in place
André Francois
AcknowledgementsAcknowledgements
André Francois
• Patients living with HIV in sub-Saharan Africa
• MSF and Ministry of Health staff in our projects in sub-Saharan Africa